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HEALTH LITERACY What You Need To Know and What You Can Do About It

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Title: HEALTH LITERACY What You Need To Know and What You Can Do About It


1
HEALTH LITERACYWhat You Need To Know and What
You Can Do About It
2
Objectives
At the end of this presentation, you will be able
to
  • Demonstrate a basic understanding of key health
    literacy concepts.
  • Communicate the importance of health literacy to
    colleagues, grantees, and contractors.
  • Identify specific ways to integrate health
    literacy into your work.

2
3
Overview
  • What is health literacy and why is it important?
  • Health literacy at HHS
  • Strategies for improving health literacy
  • Integrating health literacy into your work
  • Resources

3
4
What Is Health Literacy and Why Is It Important?
5
What Is Health Literacy?
This slide contains video clips of patients
discussing their health literacy experiences.
Patients describe in their own words their
difficulties reading medication labels,
understanding informed consent forms, and
following a drug regimen. In the words of one
patient, "It's just a language that I'm not
familiar with." The video is produced by the
Academy of Educational Development in
collaboration with the Institute of Medicine with
special thanks to the American Medical
Association Foundation and the National Center
for the Study of Adult Learning and Literacy.
5
6
What Is Health Literacy?
  • Health literacy is the degree to which
    individuals have the capacity to obtain, process,
    and understand basic health information and
    services needed to make appropriate health
    decisions.
  • Health literacy is dependent on both individual
    and systemic factors
  • Communication skills of lay people and
    professionals
  • Knowledge of lay people and professionals of
    health topics
  • Culture
  • Demands of the healthcare and public health
    systems
  • Demands of the situation/context

6
7
What Factors Affect Health Literacy?
  • Health literacy is dependent on the communication
    skills of lay people and health professionals.
  • Communication skills include literacy skills
    (e.g., reading, writing, numeracy), oral
    communication skills, and comprehension.
  • Communication skills are context specific.

7
8
What Factors Affect Health Literacy?
  • 2. Health literacy is dependent on lay person
    and professional knowledge of various health
    topics.
  • People with limited or inaccurate knowledge about
    the body and the causes of disease may not
  • Understand the relationship between lifestyle
    factors (such as diet and exercise) and health
    outcomes
  • Recognize when they need to seek care
  • Health information can overwhelm people with
    advanced literacy skills.

8
9
What Factors Affect Health Literacy?
  • 3. Health literacy is dependent on culture.
  • Culture affects
  • How people communicate and understand health
    information
  • How people think and feel about their health
  • When and from whom people seek care
  • How people respond to recommendations for
    lifestyle change and treatment

9
10
What Factors Affect Health Literacy?
  • 4. Health literacy is dependent on the demands
    of the healthcare and public health systems.
  • Individuals need to read, understand, and
    complete many kinds of forms in order to receive
    treatment and payment reimbursement.
  • Individuals need to know about the various types
    of health professionals and services as well as
    how to access care.

10
11
What Factors Affect Health Literacy?
  • 5. Health literacy is dependent on the demands of
    the situation/context.
  • Health contexts are unusual compared to other
    contexts because of an underlying stress or fear
    factor.
  • Healthcare contexts may involve unique conditions
    such as physical or mental impairment due to
    illness.
  • Health situations are often new, unfamiliar, and
    intimidating.

11
12
What health literacy is NOT
  • Health literacy is NOT
  • Plain Language. Plain language is a technique for
    communicating clearly. It is one tool for
    improving health literacy.
  • Cultural Competency. Cultural competency is the
    ability of professionals to work
    cross-culturally. It can contribute to health
    literacy by improving communication and building
    trust.

12
13
Why Is Health Literacy Important?
  • Health literacy is important because it affects
    peoples ability to
  • Navigate the healthcare system, including
    locating providers and services and filling out
    forms
  • Share personal and health information with
    providers
  • Engage in self-care and chronic disease
    management
  • Adopt health-promoting behaviors, such as
    exercising and eating a healthy diet
  • Act on health-related news and announcements
  • These intermediate outcomes impact
  • Health outcomes
  • Healthcare costs
  • Quality of care

13
14
Health Literacy and Health Outcomes
  • Persons with limited health literacy skills have
  • Higher utilization of treatment services
  • Hospitalization
  • Emergency services
  • Lower utilization of preventive services
  • Higher utilization of treatment services results
    in higher healthcare costs.

14
15
Health Literacy and Quality of Care
  • Health literacy affects the quality of health
    care.
  • Good quality means providing patients with
  • appropriate services, in a technically competent
  • manner, with good communication, shared
  • decisionmaking, and cultural sensitivity.
  • From IOM. Crossing the Quality Chasm A New
    Health System for the 21st Century. 2001.

15
16
Health Literacy and Shame
  • People with limited health literacy often report
    feeling a sense of shame about their skill level.
  • Individuals with poor literacy skills are often
    uncomfortable about being unable to read well,
    and they develop strategies to compensate.

16
17
Measuring Health Literacy
  • Health literacy is a new component of the 2003
    National Assessment of Adult Literacy (NAAL).
  • Nationally representative sample of more than
    19,000 adults aged 16 and older in the United
    States
  • Assessment of English literacy using prose,
    document, and quantitative scales

17
18
Measuring Health Literacy
  • Tasks used to measure health literacy were
    organized around three domains
  • Clinical Filling out a patient form
  • Prevention Following guidelines for
    age-appropriate preventive health services
  • Navigation of the healthcare system
    Understanding what a health insurance plan will
    pay for

18
19
Measuring Health Literacy
  • Proficient Can perform complex and challenging
    literacy activities.
  • Intermediate Can perform moderately challenging
    literacy activities.
  • Basic Can perform simple everyday literacy
    activities.
  • Below Basic Can perform no more than the most
    simple and concrete literacy activities.
  • Nonliterate in English Unable to complete a
    minimum number of screening tasks or could not be
    tested because did not speak English or Spanish.

19
20
Percentage of Adults in Each Literacy Level 2003
Source National Center for Education Statistics,
Institute for Education Sciences
20
21
Nonliterate in English
Source National Center for Education Statistics,
Institute for Education Sciences
21
22
Difficulty of Selected Health Literacy Tasks
0
Circle the date of a medical appointment on a
hospital appointment slip. (101) Give two
reasons a person should be tested for a specific
disease, based on information in a clearly
written pamphlet. (202) Determine what time a
person can take a prescription medication, based
on information on the drug label that relates the
timing of medication to eating. (253) Calculate
an employees share of health insurance costs for
a year, using a table. (382)
Below Basic Basic Intermediate Proficient
500
22
Source National Center for Education Statistics,
Institute for Education Sciences
23
Percentage of Adults in the Below Basic Health
Literacy NAAL Population 2003
1 The Did not obtain health information over the
Internet category does not include prison
inmates. 2 Disabilities include vision, hearing,
learning disability, and other health
problems. Source U.S. Department of Education,
Institute of Education Sciences, National Center
for Education Statistics, 2003 National
Assessment of Adult Literacy (NAAL)
23
24
Percentage of Adults in Each Health Literacy
Level, by Self-Assessment of Overall Health 2003
Source U.S. Department of Education, Institute
of Education Sciences, National Center for
Education Statistics, 2003 National Assessment of
Adult Literacy
24
25
Sources of Health Information
Percentage of adults with Below Basic or Basic
health literacy who get little or no health
information from the following sources
Source Below Basic Basic
Internet 85 70
Magazines 64 47
Books or Brochures 62 45
Newspapers 59 51
Family or Friends 47 40
Healthcare Providers 35 30
Radio or TV 33 29
Source National Center for Education Statistics,
Institute for Education Sciences
25
26
The Bottom Line
  • Only 12 percent of adults have Proficient health
    literacy. In other words, nearly 9 out of 10
    adults may lack the skills needed to manage their
    health and prevent disease.
  • Fourteen percent of adults (30 million people)
    have Below Basic health literacy. These adults
    are more likely to report their health as poor
    (42 percent) and are more likely to lack health
    insurance (28 percent) than adults with
    Proficient health literacy.

26
27
Measuring Health Literacy
  • Measures of health literacy at the individual
    level were developed in the 1990s
  • Rapid Estimate of Adult Literacy in Medicine
    (REALM)
  • Test of Functional Health Literacy in Adults
    (TOFHLA and S-TOFHLA)

27
28
Measuring Health Literacy
  • Health literacy measures based on functional
    literacy do not capture the full range of skills
    needed for health literacy.
  • Current assessment tools (for populations and
    individuals) cannot differentiate among
  • Reading ability
  • Lack of health-related background knowledge
  • Lack of familiarity with language and materials
  • Cultural differences in approaches to health.

28
29
Who Is at Risk?
  • The problem of limited health literacy is greater
    among
  • Older adults
  • Those who are poor
  • People with limited education
  • Minority populations
  • Persons with limited English proficiency (LEP)

29
30
Who Is at Risk?
  • Many of the same populations at risk for limited
    health literacy also suffer from disparities in
    health status, illness (including heart disease,
    diabetes, obesity, HIV/AIDS, oral disease, cancer
    deaths, and low birth weight), and death.

30
31
Health Literacy Use of Preventive Services
  • Persons with limited health literacy skills are
    more likely to skip preventive measures such as
  • Mammograms
  • Pap smears
  • Flu shots

As defined by these studies
31
32
Health Literacy Knowledge About Medical
Conditions and Treatment
  • Persons with limited health literacy skills
  • Are more likely to have chronic conditions and
    less likely to manage them effectively.
  • Have less knowledge of their illness (e.g.,
    diabetes, asthma, HIV/AIDS, high blood pressure)
    and its management.

32
33
Health Literacy Hospitalization and Health Status
  • Persons with limited health literacy skills
  • Experience more preventable hospital visits and
    admissions.
  • Are significantly more likely to report their
    health as poor.

33
34
Health Literacy Healthcare Costs
  • Predicted inpatient spending for persons with
    inadequate health literacy (measured by the
    S-TOFHLA) was 993 higher than that of persons
    with adequate health literacy.
  • An earlier analysis found that the additional
    healthcare resources attributable to inadequate
    health literacy were 29 billion (assuming that
    inadequate literacy was equivalent to inadequate
    health literacy)
  • This number would have grown to 69 billion if
    even one-half of marginally literate adults were
    also considered not health literate.

34
35
Health Literacy at HHS
36
Commitment to Health Literacy
  • Secretary Leavitt Prevention and health
    information technology (IT) are two big
    priorities for the healthcare system.
  • Secretary Thompsons Workgroup on Health Literacy
  • Prevention A Blueprint for Action
  • It is critical that individuals have access to
    health information in a way they can understand
    and make appropriate health decisions.

36
37
Office of the Surgeon General
  • Health literacy improvement is one of the Surgeon
    Generals seven public health priorities.
  • Health literacy is the currency of success for
    everything I am doing as the Surgeon General.
  • Dr. Richard Carmona in his speech to the AMA
    House of Delegates, June 2003.

37
38
Healthy People 2010 Health Communication
Objectives
  • 11-1. Internet access in the home
  • 11-2. Health literacy
  • 11-3. Research and evaluation of health
    communication programs
  • 11-4. Quality of Internet health Web sites
  • 11-5. Centers of Excellence in health
    communication
  • 11-6. Provider-patient communication

38
39
Healthy People 2010 Health Literacy Objectives
  • 11-2. Improve the health literacy of
    persons with inadequate or marginal literacy
    skills.
  • 11-6. Increase the proportion of persons who
    report that their healthcare providers have
    satisfactory communication skills.

39
40
Funding
  • NIH program announcement Understanding and
    Promoting Health Literacy
  • Three annual submission dates 20042006
  • Thirteen sponsoring institutes and offices with
    AHRQ
  • NIH spending in FY05 for these grants is close to
    3 million, and it will total more than 8
    million during the life of the awarded grants.
  • HRSA provides funding to community-based
    organizations for health literacy activities and
    research.

40
41
Health Literacy Coordination
  • Department health literacy workgroup
  • Agency health literacy workgroups
  • HHS health literacy intranet site
  • Quick Guide to Health Literacy for HHS employees
  • Health literacy action plan

41
42
Strategies for Improving Health Literacy
43
Four Strategies for Improving Health Literacy
  1. Improve the usability of health information.
  2. Improve the usability of health services.
  3. Build knowledge to improve decisionmaking.
  4. Advocate for health literacy improvement.

43
44
1. Improve the Usability of Health
Information
  • Is the information appropriate for the users?
  • Is the information easy to use?
  • Are you speaking clearly and listening carefully?

44
45
Identify the Intended Users of the Health
Information and Services
  • Know the intended users of the health information
    and services
  • Demographics
  • Behavior
  • Culture
  • Attitude
  • Literacy skills
  • Language
  • Socioeconomic status
  • Access to services
  • Decide which channel(s) and format are most
    appropriate.

45
46
Evaluation
  • Evaluate users understanding before (formative),
    during (process), and after (outcome) the
    introduction of materials.
  • Test! Test! Test!

46
47
Acknowledge Cultural Differences and Practice
Respect
  • Accepted roles of men and women
  • Value of traditional vs. Western medicine
  • Favorite or forbidden foods
  • Manner of dress
  • Body language, especially touching or proximity

47
48
What Is Cultural Competency?
  • Cultural competency is the ability of health
    organizations and practitioners to recognize the
    following in diverse populations to produce a
    positive health outcome
  • Cultural beliefs
  • Values
  • Attitudes
  • Traditions
  • Language preferences
  • Health practices

48
49
Use Plain Language
  • Plain language is a strategy for making written
    and oral information easier to understand.
  • Key elements of plain language include
  • Using simple language and defining technical
    terms
  • Using the active voice
  • Breaking down complex information into
    understandable pieces
  • Organizing information so the most important
    points come first

49
50
Speak Clearly and Listen Carefully
  • Use a medically trained interpreter if necessary
  • For those who do not speak English well, plain
    English will not help.
  • Ensure that all language access services,
    including translation, are in plain language.
  • Refer to CLAS standards.
  • Ask open-ended questions
  • Elicit cultural beliefs and attitudes Tell me
    about the problem and what may have caused it.
  • Check for understanding
  • Use the teach-back method Have the person
    restate the information in his or her own words.

50
51
Improve the Usability of Health Information on
the Internet
  • People cannot find the information they seek on
    Web sites 60 of the time.
  • Many elements that improve written and oral
    communication can be applied to information on
    the Web
  • Plain language
  • Large font
  • White space
  • Simple graphics

Dont forget Refer to the Office of Management
and Budget (OMB) Policies for Federal Public
Websites for further guidance.
51
52
Improve the Usability of Health Information on
the Internet
  • Health literacy has implications for Web-based
    communication beyond written text. Consider the
    following strategies
  • Apply user-centered design principles and conduct
    usability tests.
  • Include interactive features and personalized
    content.
  • Organize information to minimize scrolling.
  • Use uniform navigation.

52
53
2. Improve the Usability of Health Services
  • Improve the usability of health forms and
    instructions.
  • Improve the accessibility of the physical
    environment.
  • Establish a patient navigator program.

53
54
Health Forms and Instructions
  • Healthcare and public health settings rely
    heavily on forms and printed instructions
  • Medical history forms
  • Insurance forms
  • Informed consent forms
  • Child immunization records for school
  • Test results
  • Directions to the lab or pharmacy
  • Hospital discharge and home care instructions
  • Clinical research protocols and announcements

54
55
Improve the Usability of Health Forms and
Instructions
  • Revise forms to ensure clarity and simplicity.
  • Test forms with intended users and revise as
    needed.
  • Provide forms in multiple languages.
  • Offer assistance with completing forms and
    scheduling followup care.

55
56
Improve the Physical Environment
  • Settings with lots of signs and postings have a
    high literacy demand
  • Include universal symbols and clear signage in
    multiple languages.
  • Promote easy flow through healthcare facilities.
  • Create a respectful and shame-free environment.

56
57
Establish a Patient Navigator Program
  • Patient navigators are health professionals or
    community health workers who help patients
  • Evaluate their treatment options.
  • Obtain referrals.
  • Find clinical trials.
  • Apply for financial assistance.
  • Congress recently passed the Patient Navigator
    Outreach and Chronic Disease Prevention Act of
    2005.

57
58
3. Build Knowledge to Improve Decisionmaking
  • Improve access to accurate and appropriate health
    information.
  • Facilitate healthy decisionmaking.
  • Partner with educators to improve health
    curricula.

58
59
Improve Access to Accurate and Appropriate Health
Information
  • Create new mechanisms for sharing and
    distributing understandable health education
    materials
  • Create audience or language-specific databases.
  • Partner with adult educators.
  • Identify new methods for information
    dissemination
  • Cell phones, palm pilots, personalized and
    interactive content, information kiosks, talking
    prescription bottles, etc.

59
60
Improve Access to Accurate and Appropriate Health
Information
  • Form partnerships with civic and faith-based
    organizations trusted in the community.
  • Work with the media to increase awareness of
    health literacy issues.
  • Work with providers to ensure that the health
    information they share is accurate, current, and
    reliable.

60
61
Facilitate Healthy Decisionmaking
  • Use short documents that present bottom-line
    information, step-by-step instructions, and
    visual cues that highlight the most important
    information
  • People process and use a limited amount of
    information when making a decision.
  • Align health information and recommendations with
    access to services, resources, and support!

61
62
Partner With Educators
  • Co-develop adult basic education lessons on
    health topics
  • Adult learners want information that is relevant
    to their lives health content is likely to
    engage them.
  • Construct lessons in which students use
    health-related texts, forms, and content from the
    Internet.

62
63
Partner With Educators
  • The K12 education system is a critical point of
    intervention to improve health literacy.
  • Incorporate health-related tasks, materials, and
    examples into lesson plans.
  • Design and disseminate health information to
    support existing state standards.
  • Speak to students or help organize health-related
    field trips for local schools.

63
64
4. Advocate for Health Literacy Improvement
  • Make the case for improving health literacy.
  • Incorporate health literacy in mission and
    planning.
  • Establish accountability for health literacy
    activities.

64
65
Make the Case for Improving Health Literacy
  • Identify specific programs and projects affected
    by limited health literacy.
  • Target key opinion leaders with health literacy
    information
  • Explain how health literacy improvement relates
    to your mission, goals, and strategic plan.
  • Circulate relevant research and reports on health
    literacy to colleagues.
  • Post and share health literacy resources.

65
66
Incorporate Health Literacy in Mission and
Planning
  • Include goals and objectives specifically related
    to health literacy improvement in
  • Strategic plans
  • Program plans
  • Educational initiatives
  • Goals can be broad (e.g., Achieving Healthy
    People 2010 Objective 11-2) or specific to the
    mission of the office/program.

66
67
Include Health Literacy in Grants, Contracts, and
MOUs
  • Recommend that all products, materials, and forms
    be written in plain language and tested with the
    intended audiences.

67
68
Establish Accountability
  • Include health literacy improvement criteria in
    program evaluation.
  • Implement health literacy metrics.

68
69
Establish Accountability
  • Sample metrics
  • Our office will
  • Apply user-centered design principles to 75 of
    new Web pages created after January 2006.
  • Ensure that all documents intended for the public
    are reviewed by a plain language expert.
  • Provide all new employees with training in
    cultural competency and health literacy within 6
    months of their date of hire.

69
70
  • Integrating Health Literacy Into Your Work at HHS

71
Integrating Health Literacy Into Your Work at HHS
  • Communicate with the public.
  • Work with grantees and contractors.
  • Conduct and promote research.
  • Manage staff and programs.
  • Work with external stakeholders and partners.

71
72
Communicating With the Public
  • HHS communication functions include
  • Responding to public inquiries
  • Developing public health messages/campaigns
  • Developing materials, publications, Web sites
  • Improving public access to evidence-based health
    information
  • Promoting and disseminating messages, materials,
    recommendations, and guidelines
  • Working with the media/press
  • Acting as public liaisons
  • Developing and implementing communication plans
  • Providing health research results
  • Speechwriting
  • Contributing to professional and academic
    publications

72
73
Communicating With the Public
  • Example Working with the media
  • Write press releases aimed at the general public
    use plain language.
  • Provide journalists with access to health
    literacy resources
  • Create and post a health literacy backgrounder
    for journalists online (focus on data and news
    hooks).
  • Highlight health literacy angle embedded in
    routine stories.

73
74
Working With Grantees and Contractors
  • Require health literacy expertise as part of the
    skill set for the teams awarded contracts.
  • Encourage grantees to address health literacy
    issues in their work plans and deliverables.
  • Include health literacy improvement as a topic in
    all technical assistance and materials
    development grants.

74
75
Working With Grantees and Contractors
  • Example
  • Ask Funding Opportunity Announcement applicants
    to explain how their projects will contribute to
    meeting the health literacy objectives in Healthy
    People 2010.

75
76
Promoting Research
  • Integrating health literacy into research
    agendas
  • Review research portfolios.
  • Convene research agenda-setting meetings for your
    topics
  • Include colleagues from across HHS who share
    responsibility for these topics.
  • Identify health literacy research questions.
  • Communicate research findings to health
    professionals and the public (shared function
    with Communication staff).

76
77
Promoting Research
  • Example
  • Make presentations at scholarly meetings.
  • Organize symposia and sessions on health literacy
    at annual professional association meetings.
  • Publish in professional journals.

77
78
Managing Staff and Programs
  • Incorporate health literacy improvement into
    performance plans, GPRA, and PART.
  • Include health literacy activities in budget
    requests.
  • Communicate the importance of health literacy
    improvement to staff.

78
79
Managing Staff and Programs
  • Example
  • Conduct a senior-level briefing at your office or
    agency
  • Include formal presentation and handouts.
  • Tie health literacy improvement to your specific
    mission, goals, and objectives.
  • Make specific recommendations.

79
80
Working With External Stakeholders and Partners
  • External stakeholders and partners include
  • Healthcare professional organizations
  • Patient advocacy and support organizations
  • Consumer advocacy organizations
  • State, local, and tribal governments
  • Federal departments and agencies
  • Academic institutions
  • Industry trade organizations
  • Media vendors and associations

80
81
Working With External Partners
  • Arrangements may be
  • Formal (e.g., Collaborative Research and
    Development Agreements and signed letters of
    agreement)
  • Informal collaboration
  • In both cases, agencies can encourage partners
    to
  • Conduct user-centered research.
  • Evaluate the impact of enhanced understandability.

81
82
Working With External Stakeholders
  • Include representatives from your target
    population in planning, implementation, and
    evaluation.
  • Be sure to include organizations that
    represent/serve populations with limited literacy
    skills.

82
83
Working With External Stakeholders and Partners
  • Examples
  • When you are soliciting proposals for
    presentations at HHS-sponsored events, state your
    interest in receiving presentations that address
    health literacy issues.

83
84
Who Is Responsible for Improving Health Literacy?
  • A health literate America is a society in which
    health systems and institutions take
    responsibility for providing clear communication
    and adequate support to facilitate
    health-promoting actions based on understanding.
  • Institute of Medicine, 2004

84
85
Who Is Responsible for Improving Health Literacy?
  • Our job as HHS employees is to protect the health
    of all Americans.
  • Healthcare providers, public health
    professionals, health policy makers, and health
    administrators are all responsible for improving
    health literacy.

85
86
Who Is Responsible for Improving Health Literacy?
  • We are!

86
87
Resources
88
Resources
  • AHRQ ReportLiteracy and Health Outcomes (2004)
    www.ahrq.gov/clinic/epcsums/litsum.htm
  • Healthy People 2010 (2000) www.healthypeople.gov
  • Healthy People 2010 Health Literacy Action
    PlanCommunicating Health Priorities and
    Strategies for Progress (2003)
    http//odphp.osophs.dhhs.gov/projects/healthcomm/
    objective2.htm
  • IOM ReportHealth Literacy A Prescription To End
    Confusion (2004) www.iom.edu/report.asp?id19723

88
89
Resources
  • NIH Improving Health Literacy Web page
    www.nih.gov/icd/od/ocpl/resources/improvinghealth
    literacy.htm
  • NIH/AHRQ program announcementsUnderstanding and
    Promoting Health Literacy http//grants.nih.gov/g
    rants/guide/pa-files/PAR-04-116.html
    http//grants.nih.gov/grants/guide/pa-files/PAR-04
    -117.html
  • Prevention A Blueprint for Action (2004)
    http//aspe.hhs.gov/health/blueprint/

89
90
Resources
  • AHRQ Health Literacy and Cultural and Linguistic
    Competency Web page www.ahrq.gov/browse/hlitix.ht
    m
  • NLM BibliographyUnderstanding Health Literacy
    and Its Barriers (2004) www.nlm.nih.gov/pubs/cbm/
    healthliteracybarriers.html
  • CDCScientific and Technical Information Simply
    Put www.cdc.gov/communication/resources/simpput.p
    df
  • CDCynergy (CD-ROM) www.cdc.gov/communication/cdcy
    nergy.htm
  • NCIMaking Health Communication Programs Work
    (the Pink Book) www.cancer.gov/pinkbook

90
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Resources
  • Dynamic search of health literacy articles in
    PubMed http//phpartners.org/hp/health_comm.html
  • HHS university plain language course
    http//lms.learning.hhs.gov/CourseCatalog/index.cf
    m
  • Plain language Web site www.plainlanguage.gov
  • A Family Physicians Practical Guide to
    Culturally Competent Care http//cccm.thinkcultu
    ralhealth.org/
  • National Standards for Culturally and
    Linguistically Appropriate Services in Health
    Carewww.omhrc.gov/templates/browse.aspx?lvl2lv
    lID15

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